Sunday, 28 January 2018

I recently got into it with a TV writer on Twitter. Well, that isn't exactly true. What really happened is that she said something wholly offensive and completely bullshit, I called her out, and she responded with some almost-worse backpeddling bullshit which I couldn't see because she simultaneously blocked me like a fucking coward. What she actually said that incensed me I'll get back to (I promise), but who she is is somewhat more important.

The writer in question is Amy Holden Jones, who happens to be the screenwriter for "Indecent Proposal" and "Beethoven". She also is the creator of the new Fox television series "The Resident", the newest in a series of unfortunate medical dramas that have splatted on our televisions for the past several decades. I call them unfortunate because they all invariably fall into the abyss of Bullshit-In-The-Name-Of-Drama rather than attempt even a modicum of veracity. It is the reason I could never watch House MD for more than five minutes without turning it off - there would always be some kind of "OH COME ON!" moment that was so full of ridiculousness that I simply could not tolerate it any further.

So after my nasty little interaction with the creator of The Resident, I decided to sit down and watch the first episode, which Ms. Jones also happens to have written. I'm not the first doctor to do this, nor (I'm sure) will I be the last, but after seeing what Ms. Jones had to say about doctors (yes, I WILL get to that, I promise), I wanted to see how she wrote about them - what they say, how they act, etc. Keep in mind I had no idea what the show was about when I sat down, though I suspected it was about a resident (ie student doctor, junior doctor, etc). Obviously. I'll be writing this live as I watch, something I've never done before.

Strap yourselves in. I don't expect this to be a smooth ride.

The show starts in the operating theatre during what appears to be an open appendectomy, soft classical music playing in the background. At least the lights are on. So far so good. Someone (a student? A resident? THE resident? I have no idea) mentions it's her first surgery with this surgeon (so what?), and someone else (a nurse carrying a clipboard for some reason?) says she has to get a picture of the occasion. What? Weird. She summons the anaesthesiologist from around the curtain (WHAT?), which prompts the surgeon to tell them "That is totally inappropriate". I found this line startlingly accurate, because I expected him to pose along with them and yeah, that's completely inappropriate. "Aw, we're just having fun!" the anaesthesiologist replies, which of course is the first "OH, COME ON!" moment of the episode, and we're only 30 seconds in, people. The bullshit gets instantly worse when the patient wakes up, opens his eyes, and starts to move while they're all busy taking selfies.

OH, COME ON!

The anaesthesiologist runs back, but the surgeon, who is inexplicably still holding a scalpel in his hand (what does he expect to be doing with that at that point during the surgery?), nicks something right on the surface which starts squirting blood onto his face and gown. OH, COME ON! The bullshit gets EVEN DEEPER when this senior surgeon (who turns out to be the Chief of Surgery, by the way) freezes, apparently lost for ideas (like, you know, stop the fucking bleeding). The nurse with the clipboard says "YOU HAVE TO CLAMP SOMETHING!" because no one else has thought of clamping something, and apparently she somehow knows that the patient has lost two litres of blood already (in literally 20 seconds) and the surgeon has no idea what to do. Exactly one second later (yes, really) the anaesthesiologist announces the patient has lost his pulse and is in PEA arrest, (OH, COME ON!) and the surgeon starts CPR - on his abdomen.

OH, COME ON!

"CPR isn't going to put all that blood back into his body", the clipboarded nurse says sadly as the surgeon performs his worthless abdominal compressions. Exactly seventeen seconds later (yes, really) the anaesthesiologist says "It's no use", and the surgeon stops.

DRAMA.

"He is so dead!" says the dramatic nurse dramatically.

HAHAHAHAHAHAHA! No seriously, the actual line that Holden wrote for this nurse is "He is so dead." HAHAHAHAHA! DRAMA.

Everyone dramatically takes off their masks and gloves, and after a few glances across the room, the surgeon announces, "Well I think we can all agree it was the misdosed sevo {sevoflurane, an anaesthesia drug}".

WHAT?? Sure surgeons try to blame anaesthesia all the time (mostly joking), but not right in front of everyone! Oh don't worry, it gets worse.

The anaesthesiologist tries to argue it wasn't his fault because the surgeon had the scalpel in the field (true), but the surgeon instantly reminds him of another patient whose oropharynx he "ripped through" on a routine intubation, and he had covered for him then.

WHAT???!? What the ever living fuck is this supposed to be? Doctors don't cover up other doctors mistakes, especially in front of the entire operating team. We have morbidity and mortality conferences where we actively discuss mistakes, both serious and common, and everyone learns from them so that mistake doesn't get made again. We don't do quid pro quo where if I fuck up you cover for me, so that gives you a Get Out Of Fuckup Free card the next time you make a fatal error. This is such egregious bullshit I am absolutely livid and frankly shocked that this made it onto television.

IT GETS WORSE.As the members of the surgery team all discuss the situation, the nurse says "We're all on the same team here . . . right?", with the clear implication that they all need to cover for each other. Someone else says, "Maybe he had a heart attack?" WHAT??? The surgeon shuffles away as the anaesthesiologist looks at the chart and tremulously says "Yes, there's . . . some family history of heart disease." "Yes," the nurse says definitively, "his left main {coronary artery} clogged. Sudden cardiac event."

That's right, we are that chock full of some of the most putrid, absurd, repugnant blather I've ever witnessed on television, and we're only 4-and-a-half minutes into this travesty.

And we STILL haven't even met The Resident yet.

If you're worried the bullshit starts to lessen as the episode progresses, you're in for a huge disappointment. In the next scene Devon (The Resident) meets Conrad, his senior resident, who quite authoritatively tells Devon The Resident that he has to do everything he says or he can remove him from the program (uh, no you can't - you're both residents). If that weren't bad enough, Conrad gives Devon The Resident a code blue on his very first day as a doctor. Uh, no. And then Connor slaps Devon's cheat sheet away when Devon tries to reference it. You know, so he doesn't kill the patient.

OH, COME ON!

The one bit of truth in this episode comes in the next scene when Conrad chastises The Resident on continuing that code for too long, which ends up regaining the patient's heartbeat but leaves her brain dead (Jahi McMath, anyone?). "All we want to do is help our patients, but what they don't teach us in medical school is there are so many ways to do harm", Conrad philosophises.

Ouch. Very true, but very ouch.

But just when I thought the bullshit was over, it jumps right back into it with a wealthy philanthropist awaiting robotic prostate surgery which is to be done by a visiting second year resident (WHAT??), though the philanthropist wants The Surgeon to do it even though he's never even touched the robot before, not to mention the fact that prostatectomies are actually be done by urologists, not general surgeons. This is a most basic fact-checking failure that anyone in the medical field, even the radiation oncologist who created the show with Holden Jones, should have picked up.

But then Holden Jones finally shows her true colours, her agenda behind this absurdity. As The Resident worries over his brain dead patient's future and if there will be an investigation, a nurse (who happens to be Conrad's ex-girlfriend - DRAMA) tells him the hospital will probably give him a medal because they will bill thousands of dollars every day she's in the ICU. Because, she explains, "It's a huge payday for them. Medicine isn't practiced by saints . . . it's a business."

IRE RISING

If that weren't bad enough, the nurse goes on to tell The Resident of a surgical error that killed her mother after a routine test gone awry. "This happens all the time, Devon. Medical error is the third leading cause of death in the United States after cancer and heart disease."

Ok, fuck you Amy Holden Jones. FUCK YOU.

I'd like to address this "third-leading cause of death" myth before I go further. I see anti-medicine people use this "statistic" all the time, always in an attempt to make doctors in general look bad, and it drives me fucking bonkers. Fortunately I don't really have to address it fully, because Dr. David Gorski, a surgical oncologist and prolific medical blogger, has done so already. Long story short: no, medical error is NOT the third-leading cause of death, not by a long shot. The only reason Holden Jones could have possibly included this line in the show is to make doctors look bad. That is the only reason.

I had a very strong feeling that Holden Jones had an anti-doctor agenda when I started watching, but I never in a million years thought she would just put it right out there on a silver fucking platter. The reason I had that feeling was the tweet I alluded to previously. This one:

It's all there in black and white, a very real and very libelous declaration that cancer doctors are nothing but money-hungry ghouls who are paid kickbacks (which are illegal) to prescribe toxic chemotherapy to patients, even when it is no longer indicated.

ARE. YOU. FUCKING. KIDDING. ME.

Holden Jones tried to defend this indefensible statement by giving an example of one unscrupulous cancer doctor who made money by giving chemo to patients who did not need it. Yeah, that guy was an immoral asshole who abused patients and deserves every minute in prison that he got. But one example does not describe all the other oncologists around the world who chose that specialty knowing they would be dealing with some of the sickest patients, who have dedicated their lives to a specialty that can help many but save few.

On behalf of oncologists everywhere, I called her out on her bullshit:

No, oncologists are NOT paid kickbacks for giving chemo, nor are they money-hungry ghouls who give toxic drugs to sick cancer patients just to line their own pockets. This tweet is disgusting, offensive, and embarrassingly wrong. Delete it. @aholdenj@FOXTVhttps://t.co/UAnX4tE93Z

Unsurprisingly she did not seem to take this well, as she immediately blocked me. She did, however, respond to me before doing so (not that I could actually see it):

Unclear? No, Ms. Holden Jones, it was not unclear in the slightest. What you said is a vile lie and it exposed your true motive behind your writing. You made your anti-doctor sentiment more than clear through your tweets, but you managed to crystalise them very nicely with your bullshit script on your bullshit show.

If you're looking for some risible anti-doctor soap opera twaddle on which to waste an hour a week, look no further than The Resident (apparently there are more episodes to come). But if you'd like an interesting new television series that won't make you want to punch your television, set it on fire, bash it with a sledgehammer, throw it in a wood chipper, and never watch it again, try Black Mirror, Stranger Things, or Star Trek: Discovery. Or get into Game of Thrones. You still have at least a year before the final season starts.

And if you're wondering, no I will not be watching episode two.EDIT: Let me make one thing abundantly clear here. I am not upset that the show features typical television-medical-drama-bullshit. I was not looking for a scientifically accurate program, and I certainly did not find one. What pissed me off is the anti-doctor rhetoric that was rampant throughout this episode (and that apparently features prominently in another episode, as was told to me by a reader).

Wednesday, 24 January 2018

I'm sick. Yeah, I have a goddamned cold and I'm fucking sick. And when I get sick I get grouchy. Therefore I'm pissed off and generally feeling ranty. I don't think I'll have a lot cohesive to say here, so this may be a bit of an oddball post. But whatever, I'm the one who's sick so fuck it. Let's just get on with it.

Right.

I'm fucking tired of "organic". I'm tired of people who sell organic food thinking they're somehow better, and I'm tired of people who buy organic food thinking it's healthier. You aren't, and it isn't. How the fuck did organic become a thing? Organic does NOT mean "pesticide-free" (yes, "organic" farms still use pesticides), it actually just refers to any compound that contains carbon. But now it means pretentious expensive bullshit.

And I'm tired of natural. Yeah, pretty much anything that calls itself "natural". There's natural shampoo, natural dog food, natural dish soap. You know what's natural? Fucking everything. Everything on this earth comes from this earth (except perhaps meteorites). And why do so many people think natural is good? Hurricanes and tornadoes are natural. Pit vipers are natural. Deadly nightshade is natural. Arsenic is fucking natural. Nature is constantly trying to kill you, yet you think natural is good? In case you don't believe me, check out this picture from The Naked Label, a bullshit website run by a "certified nutritionist" (a certification which does not actually exist):

What's the problem, you may ask? That mushroom is Amanita muscaria, and it is fucking poisonous. Yeah, I think my bolognese is better than that poisonous fungus that nature made in order to kill me.

And I'm tired of companies jumping on the non-GMO fear-mongering bandwagon, advertising anything and everything as non-GMO. I can't tell you how many products I've seen labelled as "non-GMO verified" when they don't contain any ingredients that have ever been genetically modified. For example, you can buy non-GMO pickles:

God damn it, there is no such thing as a GMO cucumber! And if that wasn't bad enough, there is also non-GMO water. Yes, really:

You can also buy non-GMO salt:

For fuck's sake, do these fucking companies even realise what the "G" in "GMO" stands for? Genetically. GENES! Water and salt do NOT have genes! And do I really have to state what the "O" stands for? Is water a fucking organism?

Oh, and while I'm on the subject, I'm fucking sick of hearing about gluten. Sure, gluten is very bad for you if you have cœliac disease. But gluten is otherwise absolutely fine. It's just a protein found in wheat, rye, and barley, and it is not dangerous or unhealthful. But way too many people seem to think gluten is the cause of all their problems, and they simply must get it out of their diet. Just walk through a grocery store these days to see all the new "gluten-free options". Like these:

Do we see the problem here? Exactly, THERE IS NO GLUTEN IN CORN OR RICE. And there is most definitely no gluten in fucking beef. Oh, and go back up to the picture of the bottle of water up there. In addition to being non-GMO water, it's also gluten-free water. FUCKING GLUTEN FREE WATER. All these companies are doing is jumping on the very lucrative bandwagon, and it pisses me off.

And I'm tired of hearing about "real food". Don't tell me to eat real food and avoid fake food. Real food is anything with any nutritional value that I put in my mouth, chew, swallow, and later shit out. Don't tell me my Oreos are fake food, because they aren't. They contain actual food products that actually contain calories and a token tiny amount of vitamins and minerals thrown in for good measure. You know what fake food is? The bowl of plastic fruit my grandparents had on their coffee table that fooled me at least twice (that plastic apple looked really real). I know Oreos are not good for me, which is why I eat them only rarely. But they most certainly are not fake. I have no idea why "junk food" has been replaced by "fake food". Was someone offended by the term "junk food"?

And then there are the various waters. There is hydrogen water, alkaline water, pH-balanced water, supercharged water, kangen water, and all other kinds of bullshit water. Yeah, it's all bullshit. If you want water (and yes, you do), there is an unending stream of it that comes out of your tap at any time. It's pure, clean, safe, and costs about 0.01% (or less) of any of the bottled water you can buy. If your municipal water supply tastes too minerally for your taste, buy a filter. Bottled water just pisses me off almost as much as pre-peeled oranges repackaged in plastic.

I think that's about enough ranting for one day. There's only but so much ire my body can take per day. Besides, I think it's about time to redose my various cold medicines even though they don't fucking work.

And don't even get me started on quinoa and kale. Because fuck that shit.

Wednesday, 17 January 2018

Of all the stupid clichés about communication (Communication is key, communication is a two-way street, blah blah blah etc etc), my least favourite is "It isn't what you say but how you say it". And before anyone says anything, yes I understand the irony of saying "blah blah blah" while complaining about communication. Whatever. Fuck it. Anyway, don't misunderstand me - how you say something is indeed extremely important. But really, I don't care what the cliché says, because what you say is infinitely more important.

Don't believe me? Then let me tell you a short yet instructive story that should illustrate my point rather emphatically.

Bryan (not his real name™) was brought to my trauma bay one fine Sunday afternoon having been stabbed by his girlfriend about 10 times following an altercation. I didn't ask about the details, because really, who the fuck wants to know why anyone would stab someone 10 times.

"Hey there Doc, we have Bryan here. He was stabbed 9 or 10 times, we lost count. Heh heh (no one laughed at his stupid attempt at a joke). The worst one is the left chest. Oh, and the neck. Heh heh (again, no laughter). All the others look pretty superficial. Bleeding is controlled, and he's been stable for us the whole time."

The medics seemed to have gone through two or three boxes of gauze of various shapes and sizes while dressing all of Bryan's myriad wounds. Fortunately Bryan's girlfriend's knowledge of vital anatomy was on par with Donald Trump's knowledge of, well, anything, because there were no life-threatening injuries. A quick X-ray of his chest showed no penetration of the knife into the thoracic cavity, and on examination of his neck wound the platysma had not been violated. Whew. Still, he had an impressive series of lacerations on his left upper arm, left forearm, left chest, neck, left thigh, and right shoulder, all of which needed to be repaired.

I was obviously going to be busy for a while. Sigh.

After gathering all the various accoutrements required for suturing his approximately 71 cm-worth of lacerations (yes, I counted), I started irrigating each individual wound, followed by cleansing with iodine solution (yes, we still do that). As I was infiltrating the left arm wounds with lidocaine, he started mumbling something to himself. I couldn't understand most of it, but there were a few words here and there that were unmistakable:

At a loss for words, I looked imploringly over at the police officer who was standing right next to me and had been apparently waiting patiently to take Bryan's statement. He returned my quizzical glance, both of us too stunned to speak. But Bryan wasn't done. Not remotely.

I looked back at the police officer who simply smirked, shook his head, and wrote something in his little notebook, which I have to assume was something resembling "HOMICIDAL PSYCHOPATH, DO NOT LET NEAR GIRLFRIEND".

About an hour and 2,401 sutures later (I may be exaggerating slightly), Bryan was all fixed up and ready to go. I briefly went to check on another patient, and when I came back a few minutes later to give Bryan his discharge instructions ("1. Come see me in a week to get your sutures out, 2. Apply antibiotic ointment 2-3 times a day, 3) Don't kill your girlfriend"), he had a very fancy set of matching stainless steel bracelets on his wrists. I tried to question one of the other police officers who had come to take Bryan away, but all he would tell me was that "the official story had changed".

I decided to accept that and move on.

Had Bryan actually done something that warranted a moderate bloodletting? I don't know, and I will likely never find out. And to be perfectly honest, it doesn't matter one bit, because my job is to fix holes. Holes I can fix. People . . . not so much.

Regardless, what Bryan said was bad enough, and the way he said it made his situation even worse. But Bryan taught me a very important lesson: it isn't only what you say and how you say it, it's also to whom you say it.

Tuesday, 9 January 2018

I know I risk angering the Call Gods by saying this, but my trauma game has been rather slow lately. I've had very few blog-worthy stories of late, and the last thing I want to do is post a "Oops, no story this week" filler bullshit. So instead I've decided to continue a tradition from January 2015, or at least what I intended to become a tradition but instead got lost amongst the drunken idiot stories: CONFESSIONS.

Yes, I believe the best way to start a new year is not by making yet another resolution that you know will be broken by January 2 (no, you will NOT go to the gym every single day), but rather by confessing sins and starting the year clean.

So here goes. The Official DocBastard Annual Confessional continues.

Though I am a die-hard heavy metal and prog rock fan, I confess to thoroughly enjoying the song "I Want It That Way" by the Backstreet Boys. I have tried my best NOT to like it, yet I find myself singing along with it every single goddamned time I hear it, most recently this afternoon.

While I'm on the subject of songs I'm embarrassed to like, I also confess that I like "Love Yourself" by Justin Bieber. Fuck me, but that's a clever song. I hate myself for liking it.

Even though the number of followers I have doesn'timpact my self-worth, I really do want more followers on Twitter and more readers here.

I want to meet Andy Wakefield, ostensibly so I can not-so-politely tell him of the irreparable harm he has done to public health, but actually so I can punch him in his stupid fucking lying face.

I hate teaching medical students.

I hate training new surgeons even more.

I plan on retiring from clinical practice in less than 10 years.

I enjoy riling idiots on Twitter and proving them wrong.

I like challenging the Call Gods sometimes and seeing what kind of shitstorm they bring me in retaliation.

I speak to my drunk patients in the same manner I speak to my children.

I hate spam comments here almost as much as spam phone calls at home, and I wish I could round up all the spammers, put them in a small office building, and make them all call and email each other nonstop until they all die.

There have been a few times on call when I wish I could have had a beer.

I drive home drowsy after call regularly. I know it's fairly stupid, though I haven't come anywhere close to falling asleep at the wheel in about 15 years.

I am a big Star Wars fan, and I loved "The Last Jedi". It's probably my favourite Star Wars movie. I'm sure this will anger many die-hard Star Wars fans, so COME AT ME.

About Me

I am a trauma and general surgeon at two hospitals in the suburbs of a major metropolitan area. One of the hospitals is in a rather poor suburb, the other is in a very affluent suburb. I see all kinds of crazy shit at both.
Feel free to email me at docbastard1@gmail.com if you have questions, comments, or stories you want me to publish. Yes, I'll give you credit.
Don't be afraid to comment or email me. I appreciate both!